Get Aetna Gr-68744 2024-2026

Filling out the Aetna GR-68744 form for viscosupplementation injectable medication precertification can seem daunting, but this guide provides clear, step-by-step instructions to assist you. By following these guidelines, you can ensure that all necessary information is accurately submitted for review.

Follow the steps to successfully complete the Aetna GR-68744 form online.

1. Press the 'Get Form' button to access the Aetna GR-68744 form. This will allow you to open the document for completion.
2. Begin by filling out the 'Start of treatment' section, which includes the start date for the medication. Clearly indicate this date to avoid any delays.
3. In the 'Patient Information' section, provide all necessary details such as first name, last name, address, contact numbers, date of birth, allergies, current weight, height, and email. Ensure that all fields are completed and easy to read.
4. Move to the 'Insurance Information' section next. Here, you need to include the Aetna member ID number, group number, and details regarding other insurance coverage if applicable.
5. In the 'Prescriber Information' section, enter the prescriber's details, including name, contact information, and license numbers. This information is crucial for verification.
6. Complete the 'Dispensing Provider/Administration Information' section. Indicate the place of administration and provide the necessary contact details for the dispensing provider.
7. Fill in the 'Product Information' section, specifying the requested product along with dosage and frequency. Make sure to select from the preferred product options if applicable.
8. In the 'Diagnosis Information' section, enter the primary and any secondary ICD codes related to the patient's condition.
9. Complete the 'Clinical Information' section thoroughly. Answer all questions related to the patient's past treatments and current condition accurately, as this is critical for the precertification process.
10. Once all sections are filled out carefully, review the entire form for any errors. Make sure all fields are completed and legible.
11. Finally, you can save your changes, download, print, or share the completed form as needed to submit it for processing.

Start completing the Aetna GR-68744 form online to ensure timely precertification for viscosupplementation treatment.